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NPI Code Detail

MEDICARE: LATARRA PRATT

MEDICARE: LATARRA PRATT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982298386
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATARRA PRATT
Provider Business Mailing Address
First Line : 2520 CRESTWOOD DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-2113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2520 CRESTWOOD DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-2113
Country : US
Telephone Number : 131-886-8309
Fax Number : 318-868-3094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2021
Last Update Date : 03/12/2021

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Directions to “ LATARRA PRATT ” Practice Location

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